Provider Demographics
NPI:1295081263
Name:PUDENZ, JENNIFER LEIGH (FNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:PUDENZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 PARK AVE
Mailing Address - Street 2:PO BOX 25
Mailing Address - City:CALLENDER
Mailing Address - State:IA
Mailing Address - Zip Code:50523-4022
Mailing Address - Country:US
Mailing Address - Phone:515-351-9651
Mailing Address - Fax:
Practice Address - Street 1:802 KENYON RD
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5740
Practice Address - Country:US
Practice Address - Phone:515-574-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-105220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily